| NPI | 1982151411 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA 122860030) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 122860030) |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2016-09-01 |