| NPI | 1932192895 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: MO 2005024707) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: MO 2004031355) |
| Enumeration Date | 2005-08-25 |
| Last Update Date | 2011-10-24 |