| NPI | 1679582787 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301116319) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 222180) |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2020-02-14 |