| NPI | 1477338812 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: AL 2996) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: AL 6274) |
| Enumeration Date | 2023-08-25 |
| Last Update Date | 2025-06-27 |