| NPI | 1699019794 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD471631) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 350136568) |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2021-07-30 |