| NPI | 1730453200 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NE 2175) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MO 2013045549) |
| Enumeration Date | 2012-03-01 |
| Last Update Date | 2019-02-06 |