| NPI | 1720352115 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IN 36000966A) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: IN 06002912A) |
| Enumeration Date | 2012-03-02 |
| Last Update Date | 2012-03-02 |