| NPI | 1245400191 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NJ 25MP00195300) | 
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 012179-1) | 
| Enumeration Date | 2008-03-06 | 
| Last Update Date | 2013-10-02 |