| NPI | 1568746337 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 015012-1) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00267300) |
| Enumeration Date | 2011-09-28 |
| Last Update Date | 2021-03-29 |