| NPI | 1063528925 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 318818-01) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 220964) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2025-01-15 |