| NPI | 1447646849 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: PA MA057484) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00363000) |
| Enumeration Date | 2015-04-13 |
| Last Update Date | 2017-11-09 |