| NPI | 1447697479 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 5101020478) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX R5256) |
| Enumeration Date | 2013-05-31 |
| Last Update Date | 2018-08-21 |