| NPI | 1558770800 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: MD DX9856) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL AL3919) |
| 133N00000X Nutritionist (Licence: FL ND10461) | |
| Enumeration Date | 2014-08-11 |
| Last Update Date | 2023-10-24 |