| NPI | 1164650214 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: VA 0101247921) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0101247921) |
| Enumeration Date | 2009-06-28 |
| Last Update Date | 2023-01-04 |