| NPI | 1912669631 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C0008616) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MD C0008616) |
| 363AM0700X Physician Assistant, Medical (Licence: MD C0008616) | |
| Enumeration Date | 2021-10-11 |
| Last Update Date | 2023-07-18 |