| NPI | 1205064565 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD60705487) |
| Additional Taxonomies | 208600000X Surgery (Licence: RI LP01595) |
| 208600000X Surgery (Licence: RI MD14512) | |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2017-05-11 |