| NPI | 1023400942 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MN 1030) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MN A743) |
| Enumeration Date | 2015-03-02 |
| Last Update Date | 2015-03-02 |