| NPI | 1780052993 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: GA 11560) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00437500) |
| 363AM0700X Physician Assistant, Medical (Licence: MA PA5498) | |
| Enumeration Date | 2015-09-03 |
| Last Update Date | 2024-10-22 |