| NPI | 1861881724 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CA 080883) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: CA AT 4726) |
| Enumeration Date | 2015-01-15 |
| Last Update Date | 2015-01-15 |