| NPI | 1407035736 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133N00000X Nutritionist (Licence: 16409) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 17977) |
| Enumeration Date | 2007-11-02 |
| Last Update Date | 2015-08-27 |