| NPI | 1457648198 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CO CDRH.0059996) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA OP60649442) |
| Enumeration Date | 2011-07-01 |
| Last Update Date | 2024-06-27 |