| NPI | 1912565094 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2019021857) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-06111) |
| Enumeration Date | 2019-06-03 |
| Last Update Date | 2019-06-20 |