| NPI | 1124401880 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2015021392) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-05054) |
| Enumeration Date | 2015-06-30 |
| Last Update Date | 2015-06-30 |