| NPI | 1902126352 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 285382-1) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 56211-20) |
| Enumeration Date | 2010-06-08 |
| Last Update Date | 2016-11-14 |