| NPI | 1831391697 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: AZ 356) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 1138) |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2007-07-08 |