| NPI | 1790865376 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 3330-024) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: WI 3330-024) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2021-01-07 |