| NPI | 1760669519 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 005278) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT006952) |
| Enumeration Date | 2008-01-23 |
| Last Update Date | 2012-11-15 |