| NPI | 1881090272 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501018887) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: WI 1620-39) |
| Enumeration Date | 2014-11-12 |
| Last Update Date | 2019-11-07 |