| NPI | 1972682862 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MD D0050980) |
| Additional Taxonomies | 208600000X Surgery (Licence: DC MD22170) |
| 208600000X Surgery (Licence: VA 0101055001) | |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2010-07-19 |