| NPI | 1104255884 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 13660-24) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 9404) |
| Enumeration Date | 2013-11-04 |
| Last Update Date | 2017-04-18 |