NPI | 1124277603 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA053534) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NJ 25MP00210500) |
Enumeration Date | 2008-09-09 |
Last Update Date | 2021-01-26 |