| NPI | 1154888444 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WI 13906-146) |
| Enumeration Date | 2019-02-22 |
| Last Update Date | 2019-02-22 |