| NPI | 1104835354 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: DC MD0354490) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: VA 0101231459) |
| 207N00000X Dermatology (Licence: MD D0063624) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: MD D0063624) | |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2019-03-05 |