| NPI | 1629297411 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NC 103661) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 103661) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2021-03-31 |