| NPI | 1104212612 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PA MT209874) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: GA 83220) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: GA 83220) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-10 |
| Last Update Date | 2023-05-24 |