| NPI | 1790282580 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NY 004592) |
| Additional Taxonomies | 225000000X Orthotic Fitter (Licence: NY Cfo05421) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NH 1325) | |
| Enumeration Date | 2018-04-09 |
| Last Update Date | 2023-12-27 |