| NPI | 1659929446 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 023981) |
| 363A00000X Physician Assistant (Licence: NJ 25MP00550400) | |
| Enumeration Date | 2019-08-27 |
| Last Update Date | 2020-03-26 |