| NPI | 1902245764 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: ID O-1365) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101020699) |
| Enumeration Date | 2013-06-14 |
| Last Update Date | 2025-02-01 |