| NPI | 1306863030 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WA MD60661694) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: AZ 20368) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: WA MD60661694) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: AZ 20368) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: AZ 20368) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2023-09-05 |