| NPI | 1609929538 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X (Licence: AZ 46854) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 001738) |
| 2086S0129X (Licence: TX P1106) | |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2021-06-19 |