| NPI | 1164857629 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MA 2487) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 20684) |
| Enumeration Date | 2013-09-03 |
| Last Update Date | 2014-04-11 |