NPI | 1225389604 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00719100) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AZ 5290) |
363A00000X Physician Assistant (Licence: AZ 5290) | |
363AS0400X Physician Assistant, Surgical (Licence: AZ 5290) | |
363AS0400X Physician Assistant, Surgical | |
Enumeration Date | 2012-09-26 |
Last Update Date | 2025-06-16 |