| NPI | 1760886170 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00376100) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 018085) |
| Enumeration Date | 2014-10-14 |
| Last Update Date | 2019-10-10 |