| NPI | 1912980509 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: MA d/n/a) |
| Additional Taxonomies | 222Z00000X Orthotist |
| 225000000X Orthotic Fitter | |
| Enumeration Date | 2005-11-28 |
| Last Update Date | 2009-05-26 |