| NPI | 1609413335 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 12339) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 5501019309) |
| Enumeration Date | 2019-12-02 |
| Last Update Date | 2021-09-13 |