| NPI | 1104213537 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME154365) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2015-04-23 |
| Last Update Date | 2022-06-30 |