| NPI | 1053138826 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NJ 25MP00857300) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA065824) |
| 363AM0700X Physician Assistant, Medical (Licence: CA PA65185) | |
| Enumeration Date | 2024-09-24 |
| Last Update Date | 2025-10-20 |