| NPI | 1790120855 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PA MD025990-E) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: PA MD025990E) |
| Enumeration Date | 2013-05-02 |
| Last Update Date | 2017-11-02 |