| NPI | 1700381456 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301513080) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 29176) |
| 208600000X Surgery (Licence: MN 65884) | |
| Enumeration Date | 2018-03-26 |
| Last Update Date | 2025-07-21 |