| NPI | 1811239148 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: UT 9443652-1205) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: UT 9443652-1205) |
| Enumeration Date | 2013-03-25 |
| Last Update Date | 2021-11-05 |