| NPI | 1659785194 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: UT 10677587-1205) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: UT 10677587-1205) |
| 207N00000X Dermatology (Licence: MI 4301105645) | |
| Enumeration Date | 2014-06-12 |
| Last Update Date | 2019-03-22 |