| NPI | 1104162338 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1343675) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ 40QA01473300) |
| Enumeration Date | 2012-12-16 |
| Last Update Date | 2023-06-09 |