| NPI | 1518493014 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WA MD61232200) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA A160393) |
| Enumeration Date | 2017-05-04 |
| Last Update Date | 2021-12-10 |