NPI | 1073508875 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA10071800) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.128845) |
363A00000X Physician Assistant (Licence: NJ 25MP00112400) | |
Enumeration Date | 2005-09-19 |
Last Update Date | 2024-10-23 |