| NPI | 1396840492 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501015676) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 10503-024) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2016-04-15 |