| NPI | 1902149834 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A150381) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NJ 25MA10414900) |
| 207N00000X Dermatology (Licence: NY 294139) | |
| Enumeration Date | 2013-03-28 |
| Last Update Date | 2022-01-27 |