NPI | 1093873721 |
---|---|
Former Name | KIMBERLY WESLEY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 213E00000X Podiatrist (Licence: MO 2013007946) |
Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: TX 1623) |
Enumeration Date | 2006-12-05 |
Last Update Date | 2016-02-04 |