| NPI | 1013514280 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MI 2000000632) |
| Additional Taxonomies | 225000000X Orthotic Fitter (Licence: MI CFo05134) |
| 225700000X Massage Therapist (Licence: MI 7501001981) | |
| Enumeration Date | 2020-10-01 |
| Last Update Date | 2020-10-01 |