| NPI | 1134120959 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MI 079202456) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2007-07-08 |