| NPI | 1104936020 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD 60404605) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA G79112) |
| 208600000X Surgery (Licence: HI MD 18482) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2022-07-21 |