| NPI | 1801866231 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MO 2011010498) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: NC 108083) |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2016-08-02 |