| NPI | 1205090339 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2086S0129X  (Licence: IA DO-05195)  | 
| Additional Taxonomies | 208600000X Surgery (Licence: GA 65627)  | 
| 208600000X Surgery (Licence: IA DO-05195)  | |
| 2086S0129X  (Licence: GA 65627)  | |
| Enumeration Date | 2008-07-17 | 
| Last Update Date | 2018-08-01 |