| NPI | 1083630958 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 007049-1) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25mp00111600) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2020-09-24 |