| NPI | 1619062023 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: AR 259) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IL 216004943) |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2014-12-31 |