| NPI | 1053303115 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CO 25124) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: GA 027907) |
| 207N00000X Dermatology (Licence: VA 0101042631) | |
| 207N00000X Dermatology (Licence: NC 39079) | |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2013-02-05 |