| NPI | 1619557196 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2026-01959) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC LL86009) |
| Enumeration Date | 2021-04-09 |
| Last Update Date | 2026-09-16 |