| NPI | 1578672515 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9106540) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25mp00151100) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2012-10-16 |