| NPI | 1104535772 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00760400) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA064308) |
| Enumeration Date | 2022-11-22 |
| Last Update Date | 2023-01-17 |