| NPI | 1356637607 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101260566) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2015-00345) |
| 208600000X Surgery (Licence: GA 71145) | |
| Enumeration Date | 2011-06-24 |
| Last Update Date | 2018-06-15 |