| NPI | 1639565872 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WA MD61065973) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: WI 1893-320) |
| 207N00000X Dermatology (Licence: AZ 65556) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: WI 1893-320) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: ID MC-1248) | |
| 207N00000X Dermatology (Licence: ID MC-1248) | |
| Enumeration Date | 2015-04-14 |
| Last Update Date | 2024-01-30 |