| NPI | 1568484202 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: LA 12246r) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 12246r) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2014-10-24 |