| NPI | 1720306905 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00235500) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085.003701) |
| Enumeration Date | 2010-05-12 |
| Last Update Date | 2010-05-12 |