| NPI | 1174819510 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 295660) |
| Additional Taxonomies | 208600000X Surgery (Licence: OR PG154755) |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2018-08-21 |