| NPI | 1023306875 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CT 55228) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208600000X Surgery (Licence: VA 0101275053) | |
| Enumeration Date | 2011-07-14 |
| Last Update Date | 2025-09-04 |