| NPI | 1184172405 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: IA 122794) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer |
| Enumeration Date | 2016-09-15 |
| Last Update Date | 2025-01-09 |