| NPI | 1134259104 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: CA G084212) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA G084212) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: NY 199318) | |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2022-07-21 |