| NPI | 1821753260 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA17080) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA 60174) |
| Enumeration Date | 2021-11-01 |
| Last Update Date | 2024-05-13 |