| NPI | 1710540901 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: PA MA060516) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: 1160596) |
| 363A00000X Physician Assistant (Licence: NJ 25MP00517900) | |
| Enumeration Date | 2019-04-15 |
| Last Update Date | 2019-07-08 |