| NPI | 1902260425 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OR 201807125NP-PP) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OR 201807125NP-PP) |
| Enumeration Date | 2016-04-11 |
| Last Update Date | 2018-12-11 |