| NPI | 1003818345 |
|---|---|
| Former Name | LISA MARIE HERNANDEZ |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2001006202) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: KS 0429105) |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2011-10-07 |