| NPI | 1508066689 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: AZ 0545) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: AZ mt-02142p) |
| Enumeration Date | 2007-07-18 |
| Last Update Date | 2014-07-17 |