| NPI | 1609363290 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD61556206) |
| Additional Taxonomies | 208600000X Surgery (Licence: OR MD226017) |
| 208600000X Surgery (Licence: UT 11416305-1205) | |
| Enumeration Date | 2018-04-18 |
| Last Update Date | 2025-08-22 |