| NPI | 1154703130 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: WV 30827) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301108341) |
| Enumeration Date | 2015-06-25 |
| Last Update Date | 2021-11-17 |