| NPI | 1104402718 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TX AT5816) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: TX MT132694) |
| Enumeration Date | 2021-03-23 |
| Last Update Date | 2021-05-19 |