| NPI | 1770566713 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX M6768) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL ME91380) |
| Enumeration Date | 2005-11-23 |
| Last Update Date | 2022-01-25 |