| NPI | 1235525650 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2025-00277) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 308402) |
| Enumeration Date | 2015-04-13 |
| Last Update Date | 2025-02-13 |