| 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 |