| NPI | 1578214706 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CT 6398) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: RI PA01558) |
| Enumeration Date | 2022-01-10 |
| Last Update Date | 2024-10-03 |