| NPI | 1861972432 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT294901) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CA 2000022505) |
| Enumeration Date | 2018-08-14 |
| Last Update Date | 2018-08-21 |