| NPI | 1568752558 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: TX U3601) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.136315) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-04-12 |
| Last Update Date | 2023-07-19 |