| NPI | 1104263714 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TX S0779) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN18742) |
| Enumeration Date | 2013-05-23 |
| Last Update Date | 2019-11-13 |