| NPI | 1609217579 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD60825873) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI L2511141) |
| Enumeration Date | 2013-07-08 |
| Last Update Date | 2020-03-02 |