| NPI | 1063100683 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: UT 12468743) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: UT 12468743-4701) |
| Enumeration Date | 2023-05-01 |
| Last Update Date | 2023-05-23 |