| NPI | 1134401524 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: PA OS018714) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: PA OS018714) |
| 208D00000X General Practice (Licence: FL U02868) | |
| Enumeration Date | 2011-09-13 |
| Last Update Date | 2021-01-12 |