| NPI | 1568764637 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133N00000X Nutritionist (Licence: MD DX3700) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 23345) |
| Enumeration Date | 2010-11-23 |
| Last Update Date | 2015-12-22 |