| NPI | 1679912901 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MN 61934) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 99999) |
| 207R00000X Internal Medicine (Licence: MN 61934) | |
| Enumeration Date | 2013-06-20 |
| Last Update Date | 2021-08-17 |