| NPI | 1104941152 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501016036) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 2066) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2021-01-15 |