| NPI | 1568134807 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IN 36002710A) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: IN 06005417A) |
| Enumeration Date | 2021-10-05 |
| Last Update Date | 2021-10-05 |