| NPI | 1457433450 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0102204516) |
| Additional Taxonomies | 208600000X Surgery (Licence: HI DOS-975) |
| 208600000X Surgery (Licence: NC 2022-02751) | |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2025-09-10 |