| NPI | 1568504397 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MI 5101020760) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 011440) |
| 363A00000X Physician Assistant (Licence: MD c0003431) | |
| 208D00000X General Practice (Licence: OH 58.004442) | |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2016-08-19 |