| NPI | 1912300211 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NC 0010-09545) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: SC 2194) |
| Enumeration Date | 2014-09-30 |
| Last Update Date | 2020-06-24 |