| NPI | 1558730945 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer |
| 225700000X Massage Therapist (Licence: KY BMTMTH00222474) | |
| Enumeration Date | 2015-09-16 |
| Last Update Date | 2019-03-05 |