| NPI | 1598011900 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MO 2012011128) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2012023500) |
| Enumeration Date | 2012-08-03 |
| Last Update Date | 2012-08-03 |