| NPI | 1770571853 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TN MD 021163) |
| Additional Taxonomies | 208600000X Surgery (Licence: KY C0425) |
| 208600000X Surgery (Licence: MT MED-PHYS-LIC-78662) | |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2023-01-23 |