NPI | 1992754683 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25mp00117000) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA ma051086) |
Enumeration Date | 2006-05-09 |
Last Update Date | 2022-12-02 |