| NPI | 1689087348 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AZ 58789) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL ME135288) |
| 208D00000X General Practice (Licence: AZ 58789) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-06-10 |
| Last Update Date | 2021-06-25 |