| NPI | 1487654745 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA09155800) |
| Additional Taxonomies | 208600000X Surgery (Licence: LA 15577R) |
| 208600000X Surgery (Licence: NY 203868) | |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2014-11-20 |