| NPI | 1134564354 |
|---|---|
| Former Name | GINA RAE FREDERICKS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NY NS006779-1) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PW SC006714) |
| Enumeration Date | 2013-05-01 |
| Last Update Date | 2017-01-03 |