| NPI | 1366630402 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WY PT-1216) |
| Additional Taxonomies | 174400000X Specialist (Licence: WY PT1216) |
| Enumeration Date | 2007-10-12 |
| Last Update Date | 2015-09-02 |