| NPI | 1073866083 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO ptl.0011969) |
| Enumeration Date | 2012-10-16 |
| Last Update Date | 2023-12-18 |