| NPI | 1790091379 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: NY 14699) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NY 3798-1) |
| Enumeration Date | 2010-08-20 |
| Last Update Date | 2011-07-19 |