| NPI | 1912439043 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: KY 06069) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: VA 0102206590) |
| Enumeration Date | 2017-03-29 |
| Last Update Date | 2025-09-03 |