| NPI | 1073994455 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: CA A165032) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT209629) |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2021-07-16 |