| NPI | 1306272794 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MN 1174) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MN A877) |
| Enumeration Date | 2013-09-18 |
| Last Update Date | 2018-10-15 |