| NPI | 1164785580 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD476305) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME147113) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2024-02-12 |