| NPI | 1912763210 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00834900) |
| Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care (Licence: NJ 25MP00834900) |
| Enumeration Date | 2024-02-23 |
| Last Update Date | 2024-12-09 |