| NPI | 1619189834 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ #25MP00029100) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY #007500-1) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2007-07-08 |