| NPI | 1871750539 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 003567) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 006375-1) |
| 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00054000) | |
| Enumeration Date | 2008-05-20 |
| Last Update Date | 2012-01-23 |