| NPI | 1104931765 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: OH 36.003500) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IN 07001076A) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2012-12-05 |