| NPI | 1194777805 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WA MD00044994) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MI 4301079783) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2012-10-26 |