| NPI | 1487680427 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: MA 229284) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: NJ MA079886) |
| 208C00000X Colon & Rectal Surgery (Licence: PA MD043640L) | |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2012-10-19 |