NPI | 1871566034 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IL 096-001538) |
Additional Taxonomies | 225700000X Massage Therapist (Licence: IL 227-002594) |
Enumeration Date | 2006-02-08 |
Last Update Date | 2007-07-08 |