| NPI | 1891385548 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-12155) |
| Additional Taxonomies | 174400000X Specialist (Licence: SC 4316) |
| 207N00000X Dermatology (Licence: SC 4316) | |
| 363AM0700X Physician Assistant, Medical (Licence: SC 4316) | |
| Enumeration Date | 2021-01-26 |
| Last Update Date | 2024-07-08 |