| NPI | 1699972778 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA052782) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA7808) |
| 363A00000X Physician Assistant (Licence: NJ 25MP00366900) | |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2021-06-10 |