| NPI | 1316385396 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101256945) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2013-06-12 |
| Last Update Date | 2024-09-24 |