| NPI | 1609808773 |
|---|---|
| Former Name | VESTINIA MADONNA POLK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MD D0052474) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MD D0052474) |
| 207X00000X Orthopaedic Surgery (Licence: VA 0101231874) | |
| 207X00000X Orthopaedic Surgery (Licence: DC MD30799) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: VA 0101231874) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2013-01-28 |