NPI | 1063968618 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213E00000X Podiatrist (Licence: MI 5901400351) |
Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: MI 5901002658) |
332B00000X Durable Medical Equipment & Medical Supplies | |
Enumeration Date | 2016-09-01 |
Last Update Date | 2020-12-30 |