| NPI | 1003355504 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: KY 05226) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5151012118) |
| Enumeration Date | 2017-02-16 |
| Last Update Date | 2022-07-15 |