| NPI | 1972954667 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 13506 - 24) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501017753) |
| Enumeration Date | 2016-06-24 |
| Last Update Date | 2016-06-24 |