| NPI | 1417324005 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: KS 2000022437) |
| Enumeration Date | 2015-08-31 |
| Last Update Date | 2021-01-27 |