| NPI | 1386764504 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: VA 0102203916) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 34009035) |
| 208600000X Surgery (Licence: CA 20A10466) | |
| 208600000X Surgery (Licence: MD H75038) | |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2020-05-12 |