| NPI | 1609178136 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A132984) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2013-00996) |
| 208600000X Surgery (Licence: PA MT188328) | |
| 208C00000X Colon & Rectal Surgery (Licence: NE 26133) | |
| Enumeration Date | 2010-12-05 |
| Last Update Date | 2020-02-04 |