| NPI | 1578859880 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501301958) |
| Additional Taxonomies | 174400000X Specialist (Licence: CO 11161) |
| Enumeration Date | 2011-06-24 |
| Last Update Date | 2023-04-14 |