| NPI | 1780047969 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NC 733) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: WV 10499) |
| Enumeration Date | 2016-04-04 |
| Last Update Date | 2022-10-07 |