| NPI | 1962867069 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA057951) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00385400) |
| 363A00000X Physician Assistant (Licence: DE C5-0001035) | |
| Enumeration Date | 2015-12-16 |
| Last Update Date | 2015-12-16 |