| NPI | 1790985489 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: SC 4110) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: SC 254) |
| Enumeration Date | 2007-07-20 |
| Last Update Date | 2007-07-20 |