| NPI | 1043875123 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: KY 080702119) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: KY 164841) |
| Enumeration Date | 2019-05-05 |
| Last Update Date | 2019-05-05 |