| NPI | 1902804024 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: GA 5776) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: CO 5721) |
| 111NS0005X Chiropractor, Sports Physician (Licence: OR 3958) | |
| 111NS0005X Chiropractor, Sports Physician (Licence: MI 2301009286) | |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2009-09-02 |