| NPI | 1811381395 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: LA 329230) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 259744) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-03-23 |
| Last Update Date | 2021-12-01 |