| NPI | 1215231055 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME121083) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT-193884) |
| 208600000X Surgery (Licence: TX P7272) | |
| Enumeration Date | 2011-01-10 |
| Last Update Date | 2019-04-11 |