| NPI | 1174032072 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 300680) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: 200033619) |
| Enumeration Date | 2017-09-22 |
| Last Update Date | 2021-09-23 |