| NPI | 1194069997 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA055932) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT020556) |
| Enumeration Date | 2012-11-16 |
| Last Update Date | 2022-01-03 |