| NPI | 1417293630 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501015104) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0012424) |
| Enumeration Date | 2012-12-15 |
| Last Update Date | 2014-02-05 |