| NPI | 1972203792 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WV 2785) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: WV 1551) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2023-03-09 |
| Last Update Date | 2023-12-13 |