| NPI | 1710350061 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00378300) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA057805) |
| 363A00000X Physician Assistant (Licence: DE C50001024) | |
| Enumeration Date | 2015-11-09 |
| Last Update Date | 2024-01-26 |