NPI | 1760469514 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NJ MP00120900) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MN 1710) |
363AM0700X Physician Assistant, Medical (Licence: CT 001831) | |
Enumeration Date | 2005-12-22 |
Last Update Date | 2020-04-29 |