| NPI | 1992797534 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD60113850) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 101290) |
| Enumeration Date | 2005-08-19 |
| Last Update Date | 2011-03-22 |