| NPI | 1700189248 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: SC 080402325) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: SC 5945) |
| Enumeration Date | 2010-12-06 |
| Last Update Date | 2010-12-06 |