| NPI | 1780661413 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA C166294) |
| Additional Taxonomies | 208600000X Surgery (Licence: ID M-17486) |
| 208D00000X General Practice (Licence: HI MD-13623) | |
| Enumeration Date | 2005-12-23 |
| Last Update Date | 2025-07-25 |