| NPI | 1790957520 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 208800000X Urology (Licence: WA MD60235724) | 
| Additional Taxonomies | 208800000X Urology (Licence: OH 35.088930) | 
| Enumeration Date | 2008-04-01 | 
| Last Update Date | 2013-08-26 |