| NPI | 1265669956 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: SD 9138) |
| Additional Taxonomies | 208600000X Surgery (Licence: IA R-8763) |
| 208600000X Surgery (Licence: ME TD151001) | |
| Enumeration Date | 2009-06-19 |
| Last Update Date | 2015-09-15 |