| NPI | 1023192747 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: TX J7836)  | 
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: WA MD00041914)  | 
| 2086S0120X Surgery, Pediatric Surgery (Licence: ND PT13389)  | |
| Enumeration Date | 2006-10-25 | 
| Last Update Date | 2020-08-03 |