| NPI | 1568456564 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 177830-1) |
| Additional Taxonomies | 207NP0225X Dermatology, Pediatric Dermatology (Licence: NY 177830-1) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: NY 177830-1) | |
| Enumeration Date | 2005-09-06 |
| Last Update Date | 2011-10-18 |