NPI | 1114222940 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00245800) |
Additional Taxonomies | 208600000X Surgery (Licence: NC 0010-08477) |
Enumeration Date | 2011-01-26 |
Last Update Date | 2019-01-17 |