| NPI | 1124472162 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 305575) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX S2514) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: NY 305575) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: TX S2514) | |
| Enumeration Date | 2016-04-15 |
| Last Update Date | 2020-07-08 |