| NPI | 1780959759 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NC 2024-00309) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NC 2024-00309) |
| Enumeration Date | 2012-03-09 |
| Last Update Date | 2024-09-09 |