| NPI | 1790779965 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 17199) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC PT870252) |
| Enumeration Date | 2005-09-02 |
| Last Update Date | 2010-07-09 |