| NPI | 1770644502 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: NJ 25MP00080900) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110-002591) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2012-02-01 |