| NPI | 1760869069 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD61085818) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 300489) |
| 208600000X Surgery (Licence: AZ 59809) | |
| Enumeration Date | 2015-05-06 |
| Last Update Date | 2021-05-26 |