| NPI | 1700173770 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2011-06-29 |
| Last Update Date | 2011-06-29 |