| NPI | 1679806384 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: OR MD169350) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT195663) |
| Enumeration Date | 2009-09-13 |
| Last Update Date | 2020-11-05 |