| NPI | 1194259127 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CO DR.0077635) |
| Additional Taxonomies | 2086S0129X (Licence: CO DR.0077635) |
| 208600000X Surgery (Licence: PA MD483012) | |
| Enumeration Date | 2017-04-17 |
| Last Update Date | 2026-06-30 |