NPI | 1720366883 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207N00000X Dermatology (Licence: WA MD61211976) |
Additional Taxonomies | 207N00000X Dermatology (Licence: CO TL.0006955) |
208600000X Surgery (Licence: AZ R72567) | |
Enumeration Date | 2011-07-23 |
Last Update Date | 2021-10-12 |