| NPI | 1750895140 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: FL PA9110603) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL 9110603) |
| Enumeration Date | 2017-11-22 |
| Last Update Date | 2019-07-03 |