| NPI | 1174811780 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD61152046) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 292357) |
| Enumeration Date | 2011-07-17 |
| Last Update Date | 2022-05-23 |