| NPI | 1972013886 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CO AT.0001638) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: CO MT.0019804) |
| Enumeration Date | 2017-10-05 |
| Last Update Date | 2017-10-05 |