| NPI | 1013108562 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00341400) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL AL2282) |
| 363A00000X Physician Assistant (Licence: NJ 25MP00341400) | |
| 363A00000X Physician Assistant (Licence: SC 5049) | |
| 363A00000X Physician Assistant (Licence: CA 59880) | |
| Enumeration Date | 2007-08-08 |
| Last Update Date | 2024-07-31 |