| NPI | 1679012868 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OH 34.014997) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MI 5151011140) |
| 207N00000X Dermatology (Licence: KY 05037) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-02-21 |
| Last Update Date | 2021-06-29 |