| NPI | 1154495950 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CT 030597) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 1821531) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2015-09-29 |