| NPI | 1013099449 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NJ 25MP 00046600) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 005259) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2007-07-08 |