| NPI | 1659959088 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X (Licence: MN 82087) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WI 81180) |
| Enumeration Date | 2021-03-29 |
| Last Update Date | 2026-06-05 |