| NPI | 1285300475 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA212971) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NC 0010-11373) |
| 363A00000X Physician Assistant (Licence: NC 0010-11373) | |
| Enumeration Date | 2021-08-18 |
| Last Update Date | 2022-10-13 |