| NPI | 1417388711 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MA PA7118) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.004555RX) |
| 363A00000X Physician Assistant (Licence: DE C5-0001101) | |
| 363A00000X Physician Assistant (Licence: VA 0110004310) | |
| Enumeration Date | 2013-12-11 |
| Last Update Date | 2021-08-05 |