| NPI | 1700229366 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35.142107) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 5122 - 850) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301502013) | |
| Enumeration Date | 2013-04-14 |
| Last Update Date | 2021-06-15 |