| NPI | 1023702891 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116037897) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: OH 36.004242) |
| Enumeration Date | 2023-06-06 |
| Last Update Date | 2026-05-18 |