| NPI | 1922204130 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X (Licence: MS 21286) |
| Additional Taxonomies | 208600000X Surgery (Licence: MS T-1879) |
| 2086S0129X (Licence: NE 28021) | |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2021-09-22 |