| 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 |