| NPI | 1811191703 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA051180) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25mp00088000) |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2008-10-07 |