| NPI | 1417111576 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MT 12755) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD70010853) |
| Enumeration Date | 2008-07-17 |
| Last Update Date | 2025-06-09 |