| NPI | 1659304012 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OR MD150947) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD00043555) |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2021-03-29 |