| NPI | 1417130147 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA PA19475) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: CA PA19475) |
| Enumeration Date | 2007-12-17 |
| Last Update Date | 2021-10-25 |