| NPI | 1902026354 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 7924) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MN Registration # 1711) |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2010-01-26 |