| NPI | 1720120280 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35060018) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 266781) |
| 2086S0127X Surgery, Trauma Surgery (Licence: WI 64084-20) | |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2020-12-27 |