| NPI | 1821416025 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WA MD61265686) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA A156381) |
| 207N00000X Dermatology (Licence: NY 319702) | |
| Enumeration Date | 2014-04-03 |
| Last Update Date | 2023-10-18 |