| NPI | 1194439620 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MI 0895025557) |
| Additional Taxonomies | 225000000X Orthotic Fitter |
| Enumeration Date | 2023-01-10 |
| Last Update Date | 2023-01-10 |