| NPI | 1154965481 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 023957) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00541300) |
| Enumeration Date | 2019-10-30 |
| Last Update Date | 2019-10-30 |