| NPI | 1942629340 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A174697) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: CO DR.0064365) |
| 2086S0129X (Licence: AZ 78692) | |
| Enumeration Date | 2014-04-14 |
| Last Update Date | 2026-01-08 |