| NPI | 1619307097 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501001970) |
| Additional Taxonomies | 174400000X Specialist (Licence: MI 5501001970) |
| Enumeration Date | 2013-11-20 |
| Last Update Date | 2018-07-11 |