| NPI | 1720143696 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101250864) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 110343) |
| 208600000X Surgery (Licence: TX N8463) | |
| 174400000X Specialist (Licence: KY TP913) | |
| 208600000X Surgery (Licence: KY 40681) | |
| 174400000X Specialist (Licence: TX N8463) | |
| Enumeration Date | 2006-12-22 |
| Last Update Date | 2026-01-15 |