| NPI | 1720167505 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 1531) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: OK 111) |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2010-10-13 |