| NPI | 1649619990 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35.134132) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA 203020) |
| 208600000X Surgery (Licence: PA MT203559) | |
| Enumeration Date | 2013-06-20 |
| Last Update Date | 2025-09-23 |