| NPI | 1336605765 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 0229481) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00507100) |
| Enumeration Date | 2019-02-11 |
| Last Update Date | 2019-03-05 |