| NPI | 1073047569 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME162987) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NJ 25MA11018600) |
| Enumeration Date | 2017-04-12 |
| Last Update Date | 2024-03-28 |