| NPI | 1124685979 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NC 2023-00149) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 10957) |
| 363A00000X Physician Assistant (Licence: NC 2023-00149) | |
| Enumeration Date | 2019-05-28 |
| Last Update Date | 2023-05-24 |