| NPI | 1528401205 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 208600000X Surgery (Licence: AZ 63840)  | 
| Additional Taxonomies | 208600000X Surgery (Licence: MD 1528401205)  | 
| Enumeration Date | 2013-04-11 | 
| Last Update Date | 2021-09-08 |