| NPI | 1083058093 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: KY 50852) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL ME134011) |
| 207R00000X Internal Medicine (Licence: OH 57.022869) | |
| Enumeration Date | 2013-04-21 |
| Last Update Date | 2020-09-04 |