| NPI | 1790721421 |
|---|---|
| Former Name | TANYA REDDICK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX N1109) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ 25ma08064100) |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2008-12-17 |