| NPI | 1700191848 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301095943) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT205003) |
| Enumeration Date | 2010-08-12 |
| Last Update Date | 2013-06-17 |