| NPI | 1982301883 |
|---|---|
| Other Name | ALEXANDRIA DETWILER PROVENCIO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX 2139077) |
| Enumeration Date | 2023-02-10 |
| Last Update Date | 2023-02-10 |