| NPI | 1902008691 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: VA 0101250155) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MN 50035) |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2012-12-18 |