| NPI | 1982242947 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: AL 1756) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: AL PTA7694) |
| Enumeration Date | 2019-12-20 |
| Last Update Date | 2019-12-20 |