| NPI | 1912972233 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: NJ 25MT00064800) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA14060) |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2007-07-08 |