| NPI | 1528204153 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 73617) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 10112-024) |
| 363A00000X Physician Assistant (Licence: MO 2017007775) | |
| Enumeration Date | 2009-01-03 |
| Last Update Date | 2024-07-08 |