| NPI | 1588958797 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2020-03125) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT199763) |
| Enumeration Date | 2011-06-06 |
| Last Update Date | 2021-09-03 |