| NPI | 1326674441 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MI 5601009975) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MI 5601009975) |
| Enumeration Date | 2020-03-20 |
| Last Update Date | 2021-06-03 |