| NPI | 1164672721 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL PA9104766) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PAT9104766) |
| Enumeration Date | 2008-09-19 |
| Last Update Date | 2010-08-04 |