| NPI | 1780950162 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 295489-1) |
| Additional Taxonomies | 208600000X Surgery (Licence: CT 56307) |
| Enumeration Date | 2012-03-29 |
| Last Update Date | 2022-07-21 |