| NPI | 1912392085 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD61218866) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0101260765) |
| 171000000X Military Health Care Provider (Licence: WA MD61218866) | |
| 208600000X Surgery (Licence: VA 0101260765) | |
| Enumeration Date | 2015-04-05 |
| Last Update Date | 2023-01-03 |