| NPI | 1104203058 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 2020020222) |
| Additional Taxonomies | 208600000X Surgery (Licence: KS 04-43151) |
| Enumeration Date | 2015-04-29 |
| Last Update Date | 2020-08-05 |