| NPI | 1174142483 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 312664) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 312664) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-16 |
| Last Update Date | 2022-06-16 |