| NPI | 1073048773 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MN 73438) |
| Additional Taxonomies | 208D00000X General Practice (Licence: IA MD-45465) |
| 171000000X Military Health Care Provider | |
| Enumeration Date | 2017-05-01 |
| Last Update Date | 2024-02-13 |