NPI | 1376206219 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA15165) |
Additional Taxonomies | 207N00000X Dermatology (Licence: CA 60106) |
Enumeration Date | 2021-10-18 |
Last Update Date | 2022-01-13 |