| NPI | 1942590583 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MT 104134) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OR PA158092) |
| 363A00000X Physician Assistant (Licence: OR PA158092) | |
| Enumeration Date | 2011-04-17 |
| Last Update Date | 2022-05-12 |