| NPI | 1043713712 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: VA 0101267528) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0101267528) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-03-08 |
| Last Update Date | 2023-03-10 |