| NPI | 1912290339 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501011657) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 10142-24) |
| Enumeration Date | 2011-05-18 |
| Last Update Date | 2011-05-18 |