| NPI | 1790815215 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MA 1456) |
| Additional Taxonomies | 225700000X Massage Therapist |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2007-07-08 |