| NPI | 1114342318 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 2015021901) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA OS024786) |
| Enumeration Date | 2014-02-25 |
| Last Update Date | 2025-12-23 |