| NPI | 1255949046 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4351048018) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 346153) |
| Enumeration Date | 2020-07-17 |
| Last Update Date | 2026-07-19 |