| NPI | 1104119965 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: IA DO-06337) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 60593) |
| 208600000X Surgery (Licence: PA OT014156) | |
| 208600000X Surgery (Licence: WI 137-321) | |
| Enumeration Date | 2011-05-25 |
| Last Update Date | 2024-06-10 |