| NPI | 1124328125 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME121024) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT189370) |
| 208600000X Surgery (Licence: NC 2013-00610) | |
| Enumeration Date | 2010-10-25 |
| Last Update Date | 2015-04-22 |