| NPI | 1639881212 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA064253) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00893400) |
| Enumeration Date | 2022-12-15 |
| Last Update Date | 2025-01-02 |