| NPI | 1659306157 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: DC MD18955) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: VA 0101046205) |
| 208600000X Surgery (Licence: DC MD18955) | |
| 208600000X Surgery (Licence: VA 0101046205) | |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2019-01-15 |