| NPI | 1700239332 |
|---|---|
| Former Name | TIPHANI GRIMES |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IL 016-005842) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IL 135.000930) |
| Enumeration Date | 2016-07-19 |
| Last Update Date | 2021-03-02 |