NPI | 1770832131 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 207PS0010X Emergency Medicine, Sports Medicine (Licence: MI 2601000998) |
Additional Taxonomies | 2083S0010X Preventive Medicine, Sports Medicine (Licence: WA 60288345) |
225200000X Physical Therapy Assistant (Licence: MI 5502005737) | |
Enumeration Date | 2012-08-31 |
Last Update Date | 2020-09-29 |