| NPI | 1811307879 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD60657714) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 72449) |
| Enumeration Date | 2014-04-30 |
| Last Update Date | 2021-10-05 |