| NPI | 1902457104 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501021668) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 116441) |
| Enumeration Date | 2019-09-28 |
| Last Update Date | 2022-01-11 |