| NPI | 1679690333 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: VA 0101254850) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OH 35.097489) |
| 207N00000X Dermatology (Licence: MI 4301088709) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: VA 0101254850) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: VA 0101254850) | |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2021-03-03 |