| NPI | 1902391089 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MT 15027) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-05976) |
| Enumeration Date | 2018-06-29 |
| Last Update Date | 2019-12-16 |