| NPI | 1528067683 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CO CDRH.0048920) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 301241) |
| 207N00000X Dermatology (Licence: CA C159568) | |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2024-10-09 |