| NPI | 1881689677 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: TX AT1276) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: TX MT017269) |
| Enumeration Date | 2005-09-17 |
| Last Update Date | 2007-07-08 |