| NPI | 1710516562 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX W6552) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0102206956) |
| Enumeration Date | 2020-04-03 |
| Last Update Date | 2026-06-25 |