| NPI | 1235581265 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: UT 13595993-1205) |
| Additional Taxonomies | 208600000X Surgery (Licence: IA R-10749) |
| 208600000X Surgery (Licence: ID 2971942) | |
| 208600000X Surgery (Licence: CO CDR.0004541) | |
| Enumeration Date | 2016-07-01 |
| Last Update Date | 2025-08-01 |