| NPI | 1619954930 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME116831) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX L0030) |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2016-04-25 |