| NPI | 1700871803 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OR 12671) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: OR 12671) |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: OR 12671) | |
| 207ND0900X Dermatology, Dermatopathology (Licence: OR 12671) | |
| 207NI0002X Dermatology, Clinical & Laboratory Dermatological Immunology (Licence: OR 12671) | |
| Enumeration Date | 2005-09-14 |
| Last Update Date | 2010-07-26 |