| NPI | 1821528100 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: AR 333) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: AR 9219) |
| Enumeration Date | 2017-06-19 |
| Last Update Date | 2022-06-09 |