| NPI | 1679152912 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35.156051) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4351048016) |
| Enumeration Date | 2021-04-05 |
| Last Update Date | 2026-08-03 |