| NPI | 1366227597 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: LA 3657) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: LA 3657) |
| Enumeration Date | 2023-08-28 |
| Last Update Date | 2024-11-04 |