| NPI | 1053739870 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2021-02574) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 202102574) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-03-29 |
| Last Update Date | 2021-10-12 |