| NPI | 1992079883 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA4282) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MA PA4282) |
| Enumeration Date | 2012-02-24 |
| Last Update Date | 2019-10-01 |