| NPI | 1184640815 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OR MD 17669) |
| Additional Taxonomies | 207NS0135X Dermatology Procedural Dermatology (Licence: OR MD17669) |
| 207ND0900X Dermatology Dermatopathology (Licence: OR MD17669) | |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2007-10-03 |