| NPI | 1790381564 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: MN CPO03677) |
| Additional Taxonomies | 224P00000X Prosthetist (Licence: MN CPO03677) |
| Enumeration Date | 2020-12-08 |
| Last Update Date | 2020-12-08 |