| NPI | 1972952158 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MN 75736) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MA 282275) |
| 207N00000X Dermatology (Licence: WI 3920-320) | |
| Enumeration Date | 2016-06-08 |
| Last Update Date | 2025-12-05 |