| NPI | 1124377858 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: AL 37193) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT209518) |
| 208600000X Surgery (Licence: MI 4301100498) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10047654) | |
| Enumeration Date | 2012-09-10 |
| Last Update Date | 2024-01-31 |