| NPI | 1104181759 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2012-00864) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 210239) |
| Enumeration Date | 2012-07-10 |
| Last Update Date | 2025-09-05 |