| NPI | 1972161222 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 27135) |
| Enumeration Date | 2019-06-02 |
| Last Update Date | 2023-08-28 |