| NPI | 1902295751 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NJ 25MP00460900) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00460900) |
| 363AM0700X Physician Assistant, Medical (Licence: PA MA052194) | |
| Enumeration Date | 2015-01-16 |
| Last Update Date | 2024-04-26 |