| NPI | 1104687326 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1406420) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NM PT-2025-0054) |
| Enumeration Date | 2024-01-16 |
| Last Update Date | 2025-05-12 |