| NPI | 1730529389 |
|---|---|
| Former Name | AMANDA WIEST |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NJ 25MD00337700) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PA SC006506) |
| Enumeration Date | 2013-06-27 |
| Last Update Date | 2022-07-21 |