| NPI | 1861796419 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TX AT4652) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: TX MT106450) |
| Enumeration Date | 2010-12-22 |
| Last Update Date | 2010-12-22 |