| NPI | 1356971394 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9112938) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL PA9112938) |
| 207NS0135X Dermatology Procedural Dermatology (Licence: FL PA9112938) | |
| Enumeration Date | 2020-01-17 |
| Last Update Date | 2021-07-22 |