| NPI | 1518456763 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301509655) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101286352) |
| Enumeration Date | 2018-05-03 |
| Last Update Date | 2025-09-25 |