| NPI | 1578069530 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CO CDRH.0070974) |
| Additional Taxonomies | 207NS0135X Dermatology Procedural Dermatology (Licence: CO CDRH.0070974) |
| 207N00000X Dermatology (Licence: CT 71874) | |
| Enumeration Date | 2018-03-30 |
| Last Update Date | 2024-06-20 |