| NPI | 1922664119 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 312158-01) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 312158-01) |
| Enumeration Date | 2019-05-14 |
| Last Update Date | 2025-05-23 |