| NPI | 1629369590 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME138796) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2017016670) |
| 208600000X Surgery (Licence: PA MT199022) | |
| Enumeration Date | 2011-04-27 |
| Last Update Date | 2019-02-11 |