| NPI | 1356750459 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 26NJ00036100) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: PA MA056925) |
| 363AS0400X Physician Assistant Surgical (Licence: NJ 26NJ00036100) | |
| Enumeration Date | 2014-08-04 |
| Last Update Date | 2020-06-15 |