| NPI | 1972995058 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 321094) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX W6565) |
| Enumeration Date | 2015-02-25 |
| Last Update Date | 2026-09-23 |