| NPI | 1962843631 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MI 4301103176) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA a148309) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301103176) | |
| Enumeration Date | 2013-07-10 |
| Last Update Date | 2021-04-29 |