| NPI | 1730574781 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2025-02396) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA11629300) |
| 208600000X Surgery (Licence: PA MD474840) | |
| Enumeration Date | 2015-04-06 |
| Last Update Date | 2025-08-21 |