| NPI | 1912499989 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MB12225400) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 73587) |
| Enumeration Date | 2018-06-05 |
| Last Update Date | 2025-12-16 |