| NPI | 1598064792 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA10880700) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 83301) |
| Enumeration Date | 2011-03-28 |
| Last Update Date | 2020-10-05 |