| NPI | 1568938991 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: PA MA061769) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: NJ 25MP00499100) |
| Enumeration Date | 2018-10-24 |
| Last Update Date | 2024-02-20 |