| NPI | 1568680494 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NM 2011-0588) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ 27039) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2015-03-04 |