| NPI | 1922212679 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: VA 0126000488) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: VA 0019003474) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2007-07-08 |