NPI | 1427376342 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00465900) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9105022) |
Enumeration Date | 2010-05-17 |
Last Update Date | 2018-08-23 |