NPI | 1740661131 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NJ 25MP00498000) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA057585) |
Enumeration Date | 2015-06-11 |
Last Update Date | 2024-11-14 |