| NPI | 1710118534 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MD D00763498) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL TRN14024) |
| 207N00000X Dermatology (Licence: FL ME 113773) | |
| Enumeration Date | 2009-07-28 |
| Last Update Date | 2013-08-08 |