| NPI | 1225580178 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9113338) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: FL PO4043) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: VA 0116029554) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO4043) | |
| Enumeration Date | 2016-10-26 |
| Last Update Date | 2020-10-12 |