| NPI | 1134471790 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL AL3394) |
| Additional Taxonomies | 225800000X Recreation Therapist |
| Enumeration Date | 2012-10-08 |
| Last Update Date | 2012-10-08 |