| NPI | 1518225630 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD61254831) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 57.021392) |
| 208600000X Surgery (Licence: CA A158248) | |
| Enumeration Date | 2012-04-26 |
| Last Update Date | 2022-03-14 |