| NPI | 1306010467 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207NS0135X Dermatology Procedural Dermatology (Licence: AZ 41903) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MA 234038) |
| 207N00000X Dermatology (Licence: NE 24408) | |
| 207N00000X Dermatology (Licence: ME 1108516) | |
| Enumeration Date | 2008-04-18 |
| Last Update Date | 2014-09-26 |