| NPI | 1679513212 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CT 051631) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 239556) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2014-01-06 |