| NPI | 1902228539 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501019536) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1216392) |
| Enumeration Date | 2014-01-16 |
| Last Update Date | 2020-06-17 |