| NPI | 1063037539 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME167494) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT219956) |
| Enumeration Date | 2020-06-10 |
| Last Update Date | 2024-09-05 |