| NPI | 1477579837 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME120470) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD069235L) |
| 208600000X Surgery (Licence: NJ 25MA08750100) | |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2021-02-18 |