| NPI | 1033464110 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA 20A12781) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MI 5101020094) |
| Enumeration Date | 2012-07-16 |
| Last Update Date | 2021-12-23 |