| NPI | 1164742425 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: GA 92888) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL ME116913) |
| Enumeration Date | 2010-06-09 |
| Last Update Date | 2025-04-29 |