| NPI | 1528387404 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NC 0885) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NC 7152) |
| Enumeration Date | 2010-05-18 |
| Last Update Date | 2010-05-18 |