| NPI | 1770575532 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MI 5502004056) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MI 2601000001) |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2013-09-24 |