| NPI | 1306625629 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00810500) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00810500) |
| 363AM0700X Physician Assistant, Medical (Licence: NJ 25MP00810500) | |
| Enumeration Date | 2023-09-26 |
| Last Update Date | 2023-09-26 |