| NPI | 1740627850 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 1744P3200X Specialist Prosthetics Case Management (Licence: FL CL0213592) |
| 224900000X Mastectomy Fitter | |
| 335E00000X Prosthetic/Orthotic Supplier | |
| Enumeration Date | 2013-05-30 |
| Last Update Date | 2023-11-21 |