| NPI | 1730236019 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: FL PO2077) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MD C0002656) |
| 363A00000X Physician Assistant (Licence: FL PA9102814) | |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2016-01-05 |