| NPI | 1053972281 |
|---|---|
| Former Name | BREONNA ELIZABETH BOST |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME163853) |
| Enumeration Date | 2019-06-27 |
| Last Update Date | 2023-12-06 |