| NPI | 1760437107 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: ID M-7506) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: ID M7506) |
| 207NS0135X Dermatology Procedural Dermatology (Licence: ID M-7506) | |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2011-06-14 |