| NPI | 1063648590 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: UT 308790-1205) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD60286049) |
| Enumeration Date | 2009-06-10 |
| Last Update Date | 2022-06-21 |