| NPI | 1427839562 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: LA 305989) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: LA LA9886) |
| Enumeration Date | 2023-10-12 |
| Last Update Date | 2023-10-12 |