| NPI | 1538414032 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 357724) |
| Additional Taxonomies | 224L00000X Pedorthist (Licence: WI 2061) |
| Enumeration Date | 2012-07-20 |
| Last Update Date | 2020-12-14 |