| NPI | 1124516232 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: IA 105404) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: TX AT5130) |
| Enumeration Date | 2018-04-24 |
| Last Update Date | 2020-09-29 |