| NPI | 1023543774 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA 54477) |
| 363A00000X Physician Assistant (Licence: CA 54477) | |
| 376K00000X Nurse's Aide (Licence: FL 283942) | |
| Enumeration Date | 2017-05-01 |
| Last Update Date | 2021-08-12 |