| NPI | 1669945259 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-08705) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NC 0010-08705) |
| Enumeration Date | 2019-01-07 |
| Last Update Date | 2019-01-07 |