| NPI | 1205248531 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2025-02854) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL 138058) |
| Enumeration Date | 2014-05-21 |
| Last Update Date | 2025-09-19 |