| NPI | 1053520122 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MN 58536) |
| Additional Taxonomies | 208600000X Surgery (Licence: IA R7345) |
| 208600000X Surgery (Licence: IA 38993) | |
| 208C00000X Colon & Rectal Surgery (Licence: IA 38993) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2021-03-11 |