| NPI | 1801915624 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301076612) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX L6887) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2007-07-08 |