| NPI | 1164836490 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA061194) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer |
| 363AM0700X Physician Assistant, Medical (Licence: NJ 25MP00568200) | |
| Enumeration Date | 2014-06-14 |
| Last Update Date | 2020-09-28 |