| NPI | 1619359510 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: AZ POD-001093) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MN 1045) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 135.000879) | |
| Enumeration Date | 2015-06-26 |
| Last Update Date | 2023-11-07 |