| NPI | 1508137670 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME142212) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT 21988) |
| Enumeration Date | 2012-01-22 |
| Last Update Date | 2022-03-10 |