| NPI | 1740607209 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0102204340) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2014-03-23 |
| Last Update Date | 2025-09-22 |