| NPI | 1639625783 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: PR 19660) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: OH 57.027307) |
| Enumeration Date | 2016-08-29 |
| Last Update Date | 2019-07-10 |