| NPI | 1043210594 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: WI 902-025) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: WI 902-025) |
| Enumeration Date | 2005-07-27 |
| Last Update Date | 2023-03-07 |