| NPI | 1912250499 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: NC 201700793) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL OS11886) |
| 207N00000X Dermatology (Licence: TX N7752) | |
| 207N00000X Dermatology (Licence: OK 5340) | |
| 207N00000X Dermatology (Licence: NC 201700793) | |
| Enumeration Date | 2012-10-20 |
| Last Update Date | 2020-10-05 |