| NPI | 1962936336 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA058812) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA004035) |
| 363A00000X Physician Assistant (Licence: NJ 25MP00429700) | |
| Enumeration Date | 2017-04-12 |
| Last Update Date | 2017-04-12 |