| NPI | 1780976670 |
|---|---|
| Former Name | LISE KIRSTEN WAGNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225XP0019X Occupational Therapist, Physical Rehabilitation (Licence: TX 101934) |
| Enumeration Date | 2011-05-10 |
| Last Update Date | 2011-05-10 |