| NPI | 1639519325 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MN 69776) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101020512) |
| 208600000X Surgery (Licence: WI 72068) | |
| Enumeration Date | 2013-06-27 |
| Last Update Date | 2021-08-11 |