| NPI | 1972017143 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IL 096.005626) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-11-27 |
| Last Update Date | 2023-04-27 |