| NPI | 1225856727 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA065838) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00880300) |
| Enumeration Date | 2024-10-02 |
| Last Update Date | 2024-10-02 |