| NPI | 1356513626 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0131X (Licence: TX 2104) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: TX 2104) |
| 213ES0000X Podiatrist, Sports Medicine (Licence: TX 2104) | |
| Enumeration Date | 2008-03-27 |
| Last Update Date | 2018-03-17 |