| NPI | 1942339817 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NH 0300) | 
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MA 1726) | 
| Enumeration Date | 2007-03-05 | 
| Last Update Date | 2007-07-08 |