| NPI | 1649515297 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME141862) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD60740019) |
| Enumeration Date | 2012-12-09 |
| Last Update Date | 2021-03-12 |