| NPI | 1104187327 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2017-00723) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC MMD.34738 LL) |
| Enumeration Date | 2012-06-05 |
| Last Update Date | 2018-06-16 |