| NPI | 1992069785 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 34.011115) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA OS019700) |
| Enumeration Date | 2012-06-27 |
| Last Update Date | 2019-08-19 |