| NPI | 1902173834 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: AR AT450) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: AR PTA4349) |
| Enumeration Date | 2011-11-21 |
| Last Update Date | 2025-05-14 |