| NPI | 1114335171 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 022024-1) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA056899) |
| Enumeration Date | 2014-07-22 |
| Last Update Date | 2019-06-11 |