| NPI | 1992908230 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: DC MD040114) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MD D66143) |
| 207N00000X Dermatology (Licence: NY 241626) | |
| 207N00000X Dermatology (Licence: VA 0101250733) | |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2014-12-31 |