| NPI | 1790218352 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MI 2601000965) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MI 5502003381) |
| 225700000X Massage Therapist (Licence: MI 7501006399) | |
| Enumeration Date | 2017-04-10 |
| Last Update Date | 2017-04-10 |