NPI | 1508258831 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NJ 25MP00360100) |
Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: PA DN004955) |
363A00000X Physician Assistant (Licence: PA MA057458) | |
363A00000X Physician Assistant (Licence: NJ 25MP00360100) | |
Enumeration Date | 2015-02-24 |
Last Update Date | 2020-10-22 |