| NPI | 1033503560 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NJ 25MP00364900) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA003512) |
| 363AM0700X Physician Assistant, Medical (Licence: PA MA057500) | |
| Enumeration Date | 2015-03-23 |
| Last Update Date | 2015-07-23 |