| NPI | 1891793493 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: KY PT001912) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY PT001912) |
| Enumeration Date | 2005-07-08 |
| Last Update Date | 2011-05-04 |