| NPI | 1912464595 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: VA 0110006557) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110006557) |
| Enumeration Date | 2019-03-01 |
| Last Update Date | 2020-09-23 |