| NPI | 1649221854 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: SC 920) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: SC 920) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2008-04-30 |