| NPI | 1679125959 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 11605) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: HI PT-4689) |
| Enumeration Date | 2019-07-16 |
| Last Update Date | 2019-07-16 |