| NPI | 1760812036 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: PA RT005459) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: PA MSG007522) |
| Enumeration Date | 2013-11-22 |
| Last Update Date | 2013-11-22 |