| NPI | 1174123251 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer |
| Additional Taxonomies | 207RS0010X Internal Medicine Sports Medicine (Licence: GA 058844834) |
| Enumeration Date | 2020-10-28 |
| Last Update Date | 2022-01-19 |