| NPI | 1720268667 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TN MD0000049460) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101255564) |
| 208600000X Surgery (Licence: NC 2007-00325) | |
| Enumeration Date | 2007-11-08 |
| Last Update Date | 2024-07-03 |