| NPI | 1588664130 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CO 44686) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: SC 83112) |
| 207N00000X Dermatology (Licence: VA 0101236394) | |
| Enumeration Date | 2005-07-26 |
| Last Update Date | 2020-09-14 |