| NPI | 1992229124 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NJ 25MP00560500) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: VA 0110005835) |
| Enumeration Date | 2017-07-31 |
| Last Update Date | 2020-09-10 |