| NPI | 1649751843 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA060057) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00481500) |
| 363A00000X Physician Assistant (Licence: PA OA004695) | |
| Enumeration Date | 2018-08-24 |
| Last Update Date | 2019-07-22 |