| NPI | 1659798049 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: AK 172871) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 85060) |
| 208D00000X General Practice (Licence: VA 010259555) | |
| 208600000X Surgery (Licence: VA 010259555) | |
| Enumeration Date | 2014-03-24 |
| Last Update Date | 2025-02-12 |