| NPI | 1962906909 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: VT 074.0131360) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: VT 104.0116901) |
| Enumeration Date | 2018-03-23 |
| Last Update Date | 2018-03-23 |