| NPI | 1285007443 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA057994) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: DE C5-0001039) |
| 363A00000X Physician Assistant (Licence: PA OA003704) | |
| 363A00000X Physician Assistant (Licence: NJ 25MP00399200) | |
| Enumeration Date | 2015-11-09 |
| Last Update Date | 2018-10-17 |