| NPI | 1487310967 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 13561655-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00660000) |
| Enumeration Date | 2021-11-09 |
| Last Update Date | 2024-05-20 |