| NPI | 1073701819 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00263500) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 012282) |
| 363AS0400X Physician Assistant, Surgical (Licence: NY P61126) | |
| Enumeration Date | 2007-10-05 |
| Last Update Date | 2014-09-05 |