| NPI | 1205388717 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: KS 2400183) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: KS 1400828) |
| Enumeration Date | 2016-10-31 |
| Last Update Date | 2016-10-31 |