| NPI | 1992067649 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: KY 04413) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX R3141) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-06-08 |
| Last Update Date | 2018-10-11 |