| 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 |