| NPI | 1134429665 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL 9111171) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NC 0010-03505) |
| 363A00000X Physician Assistant (Licence: AZ 4703) | |
| 363A00000X Physician Assistant (Licence: NY 017303) | |
| 363A00000X Physician Assistant (Licence: CA 22939) | |
| 363AM0700X Physician Assistant, Medical (Licence: NC 0010-03505) | |
| Enumeration Date | 2010-11-01 |
| Last Update Date | 2021-03-10 |