| NPI | 1164890752 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 018879) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00374300) |
| 363AM0700X Physician Assistant, Medical (Licence: NJ 25MP00374300) | |
| 363AM0700X Physician Assistant, Medical (Licence: NY 018879) | |
| 363AS0400X Physician Assistant, Surgical (Licence: NY 018879) | |
| 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00374300) | |
| Enumeration Date | 2015-09-13 |
| Last Update Date | 2018-12-17 |