| NPI | 1336469303 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: KY AT780) |
| Additional Taxonomies | 2471C3402X Radiologic Technologist Radiography (Licence: FL CRT54883) |
| Enumeration Date | 2010-06-01 |
| Last Update Date | 2010-06-01 |