| NPI | 1932695137 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: KY 05483) |
| Additional Taxonomies | 208600000X Surgery (Licence: KY 05843) |
| 208600000X Surgery (Licence: MI 5101024151) | |
| Enumeration Date | 2018-07-11 |
| Last Update Date | 2026-07-15 |