| NPI | 1962086686 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NY 50107436) |
| Additional Taxonomies | 246ZA2600X Specialist/Technologist, Other, Art, Medical (Licence: NY 50107436) |
| 261Q00000X Clinic/Center | |
| 374700000X Technician (Licence: NY 50107436) | |
| Enumeration Date | 2021-05-09 |
| Last Update Date | 2021-05-09 |