| NPI | 1700349982 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: AZ 008622) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ R3115) |
| Enumeration Date | 2019-04-13 |
| Last Update Date | 2023-04-20 |