| NPI | 1235113879 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA5151) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 16887) |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2014-09-19 |