| NPI | 1619153400 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: OH 1109) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: OH 3910) |
| Enumeration Date | 2008-01-11 |
| Last Update Date | 2008-01-11 |