| NPI | 1164405551 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: GA POD000806) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: TX 2162) |
| 213E00000X Podiatrist (Licence: AL 218) | |
| 213E00000X Podiatrist (Licence: PA SC004039-L) | |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2019-06-20 |