| NPI | 1912057209 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00232300) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NY 006793) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2010-08-19 |