| NPI | 1285076737 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD60966937) |
| Additional Taxonomies | 208600000X Surgery (Licence: ID M-14870) |
| Enumeration Date | 2013-07-25 |
| Last Update Date | 2025-07-18 |