| NPI | 1710473749 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 100755) |
| 225100000X Physical Therapist (Licence: ND CP015501T) | |
| Enumeration Date | 2018-07-02 |
| Last Update Date | 2022-11-07 |