| NPI | 1336371152 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: NJ 25MP002222000) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NJ 25MP002222000) |
| Enumeration Date | 2009-08-12 |
| Last Update Date | 2020-01-23 |