| NPI | 1003071580 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 208600000X Surgery (Licence: OR MD161898)  | 
| Additional Taxonomies | 208600000X Surgery (Licence: WI 128828)  | 
| Enumeration Date | 2008-07-23 | 
| Last Update Date | 2018-12-31 |