| NPI | 1720607633 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: VA 0101289393) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208600000X Surgery (Licence: VA 0101289393) | |
| Enumeration Date | 2020-04-10 |
| Last Update Date | 2026-09-22 |