| NPI | 1518565985 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: KS 24-00482) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: KS 14-01631) |
| Enumeration Date | 2020-10-16 |
| Last Update Date | 2020-10-16 |