| NPI | 1902870843 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172M00000X Mechanotherapist (Licence: VA 0019007230) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: VA 0126000734) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2011-01-21 |