| NPI | 1609046911 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WA MD60648544) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0101244382) |
| 207N00000X Dermatology (Licence: MA 253813) | |
| 208D00000X General Practice (Licence: CA A107274) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-03-04 |
| Last Update Date | 2022-07-21 |