| NPI | 1972861318 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: NY 311168) |
| Additional Taxonomies | 208600000X Surgery (Licence: MD 1111111) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: NJ 25MA11202600) | |
| Enumeration Date | 2012-04-23 |
| Last Update Date | 2022-04-14 |