| NPI | 1962754739 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00275800) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 015289) |
| Enumeration Date | 2012-10-03 |
| Last Update Date | 2012-10-03 |