| NPI | 1245630821 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: ME AT446) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: ME MT5321) |
| Enumeration Date | 2014-09-02 |
| Last Update Date | 2015-11-01 |