| NPI | 1396179453 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 550107898) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01511900) |
| Enumeration Date | 2013-08-26 |
| Last Update Date | 2018-05-04 |