| NPI | 1710213152 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: PA OA002148) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NJ 25MP00307200) |
| 363AM0700X Physician Assistant Medical (Licence: PA MA000501L) | |
| Enumeration Date | 2009-10-20 |
| Last Update Date | 2014-10-16 |