| NPI | 1023616869 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC011778) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: GA LPC011778) |
| Enumeration Date | 2020-10-14 |
| Last Update Date | 2020-11-20 |