| NPI | 1215497060 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA12801100) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 327778-01) |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2025-09-17 |