| 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 |