| NPI | 1649582214 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD461798) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 285705) |
| 208600000X Surgery (Licence: OH 127549) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: GA 003731) | |
| Enumeration Date | 2010-07-11 |
| Last Update Date | 2018-06-22 |