| NPI | 1306026703 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: TX R7657) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101016869) |
| 2086S0129X (Licence: AZ 6136) | |
| Enumeration Date | 2007-11-14 |
| Last Update Date | 2023-07-25 |