| NPI | 1518163955 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: AL 661) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: AL PTH 5078) |
| Enumeration Date | 2007-06-22 |
| Last Update Date | 2022-02-14 |