| NPI | 1811973894 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: PA MD437386) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MN 46763) |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2020-08-05 |