| NPI | 1770108375 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MD X0000) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX W1464) |
| Enumeration Date | 2020-06-10 |
| Last Update Date | 2026-07-16 |