| NPI | 1184187544 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MT218732) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA student) |
| Enumeration Date | 2019-04-11 |
| Last Update Date | 2019-07-14 |