| NPI | 1295941144 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: WA OP 60396655) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 262721-1) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2016-02-11 |