| NPI | 1417256314 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MA 250563) |
| Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: MA 250563) |
| Enumeration Date | 2011-03-18 |
| Last Update Date | 2012-05-18 |