| NPI | 1962598557 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: KY 3002620) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: KY 3002620) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2023-04-17 |