| NPI | 1073172433 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX V2200) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NC 259661) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: IA R-12787) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: TX V2200) | |
| Enumeration Date | 2019-06-10 |
| Last Update Date | 2024-06-24 |