| NPI | 1104600659 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 050854) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA02189900) |
| Enumeration Date | 2023-08-23 |
| Last Update Date | 2023-08-23 |