| NPI | 1245775444 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA OP70020242) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2016022781) |
| Enumeration Date | 2016-12-23 |
| Last Update Date | 2025-09-29 |