| NPI | 1558340554 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WA MD00035233) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA MD00035233) |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2011-05-02 |