| NPI | 1407395486 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35.136894) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: OH 35.136894) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-02-23 |
| Last Update Date | 2022-11-16 |