| NPI | 1174763643 |
|---|---|
| Former Name | COURTNEY ANNE SEVERINO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A108301) |
| Additional Taxonomies | 208600000X Surgery (Licence: NV 17320) |
| Enumeration Date | 2009-02-24 |
| Last Update Date | 2022-04-11 |