| NPI | 1467726364 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NJ 25MP00458600) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AZ 5051) |
| 363AM0700X Physician Assistant, Medical (Licence: CA PA21920) | |
| Enumeration Date | 2012-02-24 |
| Last Update Date | 2018-01-23 |