| 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 |