NPI | 1750545620 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 207N00000X Dermatology (Licence: CA A118404) |
Additional Taxonomies | 207N00000X Dermatology (Licence: PA MT-189151) |
208D00000X General Practice (Licence: UT 7004818-1205) | |
Enumeration Date | 2008-07-10 |
Last Update Date | 2012-11-06 |