| NPI | 1356798110 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 22729) |
| Enumeration Date | 2016-05-20 |
| Last Update Date | 2022-06-27 |