| NPI | 1588933469 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IL 096.001367) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: IL 227.000618) |
| Enumeration Date | 2011-12-21 |
| Last Update Date | 2011-12-21 |