| NPI | 1104170299 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IL 096.003367) |
| Additional Taxonomies | 111NR0400X (Licence: IL 096.003367) |
| Enumeration Date | 2012-10-29 |
| Last Update Date | 2012-10-30 |