| NPI | 1487673687 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME101901) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 225865) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2019-01-25 |