| NPI | 1619908795 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: GA 494) |
| Additional Taxonomies | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: GA 494) |
| 213ES0131X Podiatrist Foot Surgery (Licence: GA 494) | |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2007-07-08 |