| NPI | 1275193047 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: MT 21612) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 11571) |
| Enumeration Date | 2019-06-14 |
| Last Update Date | 2022-01-31 |