| NPI | 1750307989 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OR MD28047) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 112950) |
| 208600000X Surgery (Licence: WA MD 00049207) | |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2009-08-17 |