| NPI | 1043295991 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NY #143006) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ ma39957) |
| 174400000X Specialist (Licence: NY 143006-1) | |
| 208600000X Surgery (Licence: NJ #MA39957) | |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2014-09-05 |