| NPI | 1760938542 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CT 000067) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: CT 985233) |
| Enumeration Date | 2016-08-31 |
| Last Update Date | 2016-08-31 |