| NPI | 1407506975 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WA MD70115869) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: ID 8981406) |
| Enumeration Date | 2022-03-26 |
| Last Update Date | 2026-08-07 |