| NPI | 1730848052 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NJ 25MP00671600) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NY 02774301) |
| 208200000X Plastic Surgery (Licence: GA 14224) | |
| Enumeration Date | 2021-12-14 |
| Last Update Date | 2026-09-28 |