| NPI | 1619520764 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL 11003301) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL APRN11003301) |
| Enumeration Date | 2019-07-18 |
| Last Update Date | 2022-08-22 |