| NPI | 1609168913 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OR 177499) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CT 053925) |
| Enumeration Date | 2011-05-04 |
| Last Update Date | 2016-08-22 |