| NPI | 1780062901 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: KS 04-41834) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207N00000X Dermatology (Licence: MI 4301109227) | |
| Enumeration Date | 2015-05-07 |
| Last Update Date | 2019-06-21 |