| NPI | 1699982280 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IA 330) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: IA 01083) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2018-03-17 |