| NPI | 1922004761 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 12370) |
| Additional Taxonomies | 174400000X Specialist (Licence: WV 001799) |
| Enumeration Date | 2005-06-27 |
| Last Update Date | 2011-09-26 |