| NPI | 1104976505 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: GA POD001108) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NY N004212) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2011-01-14 |