| NPI | 1821353152 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224L00000X (Licence: 3531) |
| Additional Taxonomies | 224900000X Mastectomy Fitter (Licence: 0055) |
| 225000000X Orthotic Fitter (Licence: 0055) | |
| Enumeration Date | 2012-07-12 |
| Last Update Date | 2012-07-12 |