| NPI | 1336310168 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ MA08637700) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ 80933) |
| Enumeration Date | 2008-03-19 |
| Last Update Date | 2014-10-30 |