| NPI | 1750506069 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MT 568) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MT 1770) |
| 225100000X Physical Therapist (Licence: NE 2536) | |
| 363A00000X Physician Assistant (Licence: NE 1275) | |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2009-11-21 |