| NPI | 1962706606 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME149355) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD-438450) |
| Enumeration Date | 2011-01-10 |
| Last Update Date | 2023-05-26 |