| NPI | 1053448456 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CT 000280) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NH 1247) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2020-12-23 |