| NPI | 1235562893 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MT PTP-PT-LIC-9310) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA MA 60389508) |
| Enumeration Date | 2013-08-18 |
| Last Update Date | 2019-05-29 |