| NPI | 1912225160 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA 131351) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WA MD61083925) |
| Enumeration Date | 2010-05-12 |
| Last Update Date | 2022-01-11 |