| NPI | 1588892830 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 240034) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME103654) |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2023-04-12 |