| NPI | 1679565964 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NM md2006-0021) |
| Additional Taxonomies | 174400000X Specialist (Licence: AZ 28963) |
| 207N00000X Dermatology (Licence: GA 044009) | |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2016-04-26 |