| NPI | 1568668671 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS12430) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: FL PO3300) |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2016-02-01 |