| NPI | 1962869313 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OK PA2646) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OK 2646) |
| 363AM0700X Physician Assistant, Medical (Licence: OK 2646) | |
| Enumeration Date | 2016-01-15 |
| Last Update Date | 2018-10-17 |