| NPI | 1568996635 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: RI AT00139) |
| Enumeration Date | 2017-04-17 |
| Last Update Date | 2026-02-17 |