| NPI | 1508111493 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2012023549) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: MO 2012021652) |
| Enumeration Date | 2012-07-17 |
| Last Update Date | 2015-07-08 |