| NPI | 1710604004 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171400000X |
| Additional Taxonomies | 133NN1002X Nutritionist Nutrition, Education |
| 2255A2300X Specialist/Technologist Athletic Trainer | |
| Enumeration Date | 2022-10-26 |
| Last Update Date | 2022-10-26 |