| NPI | 1073200200 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MA 3019838) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 333512) |
| Enumeration Date | 2023-04-19 |
| Last Update Date | 2026-08-03 |