| NPI | 1861787319 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CT 69180) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD60947052) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-06-13 |
| Last Update Date | 2021-07-20 |