| NPI | 1679912901 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: VA 0101277500) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MN 61934) |
| Enumeration Date | 2013-06-20 |
| Last Update Date | 2025-07-08 |