| NPI | 1609821495 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MN 799) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: WI 784-25) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2011-05-10 |