| NPI | 1063519361 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MT MT18766) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301049881) |
| 208600000X Surgery (Licence: WY TL1402) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2012-11-08 |