| NPI | 1902075294 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00109000) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NJ MP001090) |
| 363AS0400X Physician Assistant, Surgical (Licence: NY 012408-1) | |
| Enumeration Date | 2008-02-21 |
| Last Update Date | 2015-05-18 |