| NPI | 1013367267 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 319621) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301503787) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5315075809) | |
| Enumeration Date | 2016-06-20 |
| Last Update Date | 2022-10-04 |