| NPI | 1104111707 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: ID M-16678) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL TRN23216) |
| Enumeration Date | 2011-06-13 |
| Last Update Date | 2022-08-23 |