NPI | 1962790683 |
---|---|
Former Name | CALLISTA COSTOPOULOS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: PA OS018762) |
Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA OS018762) |
Enumeration Date | 2011-07-14 |
Last Update Date | 2024-05-08 |