| NPI | 1902959737 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NJ MP00142600) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 007303) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2019-08-12 |