| NPI | 1124464979 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME151962) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NM MD2018-0169) |
| 207N00000X Dermatology (Licence: MN 57965) | |
| 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: FL ME151962) | |
| 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: NM MD2018-0169) | |
| Enumeration Date | 2013-05-21 |
| Last Update Date | 2021-12-08 |