| NPI | 1104288141 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MO 20200022867) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CT 1042) | |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2020-09-18 |