| NPI | 1194964635 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: SC 5141) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC 5141) |
| 363A00000X Physician Assistant (Licence: CA PA55567) | |
| 363AM0700X Physician Assistant Medical (Licence: FL PAT9104835) | |
| Enumeration Date | 2009-02-06 |
| Last Update Date | 2024-04-30 |