| NPI | 1508261314 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: NJ 25MP00349800) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 018088) |
| 363AS0400X Physician Assistant Surgical | |
| Enumeration Date | 2014-10-23 |
| Last Update Date | 2018-08-20 |