| NPI | 1568995504 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: SC 702) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: SC 702) | |
| Enumeration Date | 2017-04-06 |
| Last Update Date | 2021-04-26 |