| NPI | 1073607669 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: DC PA031176) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: DC PO548) |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: MD 01180) | |
| 363A00000X Physician Assistant (Licence: MD C0005623) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2023-12-27 |