| NPI | 1538512850 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: UT 12286308-1204) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 299297) |
| Enumeration Date | 2016-07-21 |
| Last Update Date | 2021-05-25 |