| NPI | 1790162097 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 209901) |
| Additional Taxonomies | 208600000X Surgery (Licence: KS 04-50251) |
| Enumeration Date | 2015-05-06 |
| Last Update Date | 2025-09-29 |