| NPI | 1205327202 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NJ 25MP00542700) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: PA MA059777) |
| 363A00000X Physician Assistant (Licence: PA MA05977) | |
| 363A00000X Physician Assistant (Licence: NJ 25MP00542700) | |
| Enumeration Date | 2018-05-24 |
| Last Update Date | 2021-08-06 |