| NPI | 1164830519 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 7492) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00342000) |
| 363AM0700X Physician Assistant, Medical (Licence: AZ 7492) | |
| Enumeration Date | 2014-07-29 |
| Last Update Date | 2020-03-09 |