| NPI | 1174903553 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MN 62851) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WI 69952) |
| Enumeration Date | 2015-06-01 |
| Last Update Date | 2021-03-19 |