| NPI | 1457622714 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL MH16317) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2012-01-19 |
| Last Update Date | 2023-09-20 |