| NPI | 1912097791 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35068524) |
| Additional Taxonomies | 208600000X Surgery (Licence: WV 16743) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2008-11-10 |