| NPI | 1639394877 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: TX MT015175) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX MT015175) |
| Enumeration Date | 2007-04-14 |
| Last Update Date | 2011-03-16 |