| NPI | 1033453907 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 001003912) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00455500) |
| Enumeration Date | 2012-11-16 |
| Last Update Date | 2021-12-09 |