| NPI | 1508917097 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MO 2008011716) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2002020507) |
| Enumeration Date | 2007-01-13 |
| Last Update Date | 2015-02-27 |