| NPI | 1902212566 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: 5501012415) |
| Additional Taxonomies | 174400000X Specialist (Licence: MI 5501012415) |
| Enumeration Date | 2014-07-03 |
| Last Update Date | 2021-01-29 |