| NPI | 1124073705 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301060606) |
| Additional Taxonomies | 208600000X Surgery (Licence: KS 04-28978) |
| 208600000X Surgery (Licence: CO 50657) | |
| 208600000X Surgery (Licence: TX k4149) | |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2021-03-29 |