| NPI | 1063758290 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: MN 58132) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY ASO552489388) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-12-16 |
| Last Update Date | 2016-05-12 |