| NPI | 1366965451 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 046679) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer |
| 146N00000X Emergency Medical Technician, Basic (Licence: NY 424083) | |
| Enumeration Date | 2017-07-20 |
| Last Update Date | 2020-12-02 |