| NPI | 1720517444 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301514696) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 60331227) |
| Enumeration Date | 2017-06-06 |
| Last Update Date | 2025-08-18 |