| NPI | 1841458619 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: TX P1000) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NV SL0521) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: FL OS11005) | |
| Enumeration Date | 2008-05-29 |
| Last Update Date | 2019-06-06 |