| NPI | 1104317999 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: SC 92979) |
| Additional Taxonomies | 208600000X Surgery (Licence: UT 13271767-1205) |
| 208600000X Surgery (Licence: SC LL52459) | |
| 208C00000X Colon & Rectal Surgery (Licence: UT 13271767-1205) | |
| Enumeration Date | 2018-05-29 |
| Last Update Date | 2024-10-01 |