| NPI | 1649489782 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: VA 0102203079)  | 
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MI 5101016343)  | 
| Enumeration Date | 2007-05-22 | 
| Last Update Date | 2012-10-18 |