| NPI | 1104016336 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery Surgical Critical Care (Licence: AZ 57677) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 57.007748) |
| 208600000X Surgery (Licence: WA MD61445220) | |
| Enumeration Date | 2007-07-25 |
| Last Update Date | 2025-07-09 |