| NPI | 1457336034 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL AL56) |
| Additional Taxonomies | 225000000X Orthotic Fitter |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2007-08-29 |