| NPI | 1104096650 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101253279) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2011-00718) |
| 208600000X Surgery (Licence: PA MD426779) | |
| Enumeration Date | 2008-03-11 |
| Last Update Date | 2024-02-20 |