| NPI | 1184156762 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207N00000X Dermatology (Licence: DC MD210002405) | 
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program | 
| Enumeration Date | 2017-04-01 | 
| Last Update Date | 2022-09-16 |