| NPI | 1255844700 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC LL87743) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305211627) |
| Enumeration Date | 2017-11-07 |
| Last Update Date | 2025-12-09 |