| NPI | 1104116136 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: TX R8056) |
| Additional Taxonomies | 208600000X Surgery (Licence: LA DO.301845) |
| Enumeration Date | 2011-04-11 |
| Last Update Date | 2021-04-02 |