| NPI | 1043625809 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9108194) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00337400) |
| Enumeration Date | 2014-06-30 |
| Last Update Date | 2025-04-01 |