| NPI | 1891094363 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301117327) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD60370201) |
| Enumeration Date | 2011-03-22 |
| Last Update Date | 2019-09-03 |