| NPI | 1558706564 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MB09608600) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 272882) |
| 208600000X Surgery (Licence: NY 272882-1) | |
| Enumeration Date | 2013-05-03 |
| Last Update Date | 2022-05-24 |