| NPI | 1992116362 |
|---|---|
| Former Name | DIANNE MARIE GUTIERREZ FONG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CA 10427) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NY 008915) |
| Enumeration Date | 2014-05-19 |
| Last Update Date | 2014-05-19 |