| NPI | 1528217114 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: MO 2005010724) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: MO 2012018842) |
| 225700000X Massage Therapist (Licence: MO 2005007414) | |
| Enumeration Date | 2008-09-18 |
| Last Update Date | 2017-08-18 |