| NPI | 1780494781 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CT 6930) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 6930) |
| Enumeration Date | 2025-01-10 |
| Last Update Date | 2025-01-10 |