| NPI | 1851679088 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL FLPT15121) |
| Additional Taxonomies | 171W00000X Contractor (Licence: MA 19646) |
| 208100000X Physical Medicine & Rehabilitation (Licence: CA CAPT38645) | |
| Enumeration Date | 2011-07-21 |
| Last Update Date | 2012-08-01 |