| NPI | 1083893218 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: PA MA059602) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00465500) |
| 363AM0700X Physician Assistant Medical (Licence: CO 2470) | |
| Enumeration Date | 2007-10-24 |
| Last Update Date | 2021-04-16 |