| NPI | 1366602690 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX P3578) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MO 2012006736) |
| 207N00000X Dermatology (Licence: KS 0435749) | |
| Enumeration Date | 2008-06-10 |
| Last Update Date | 2015-03-19 |