| NPI | 1376746354 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2086S0129X  (Licence: IA 37401)  | 
| Additional Taxonomies | 208600000X Surgery (Licence: IA R6886)  | 
| 208600000X Surgery (Licence: IA 37401)  | |
| Enumeration Date | 2007-06-07 | 
| Last Update Date | 2025-04-22 |