| NPI | 1215336003 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: KS 03013) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: KS 14-02700) |
| Enumeration Date | 2014-08-18 |
| Last Update Date | 2021-03-19 |