| NPI | 1548484033 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00155400) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: IL 085-001212) |
| 363AS0400X Physician Assistant, Surgical (Licence: NY 011342-1) | |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2009-01-21 |