| NPI | 1053695742 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TX 6596) |
| Additional Taxonomies | 171W00000X Contractor (Licence: OK 0417) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: OK 417) | |
| Enumeration Date | 2011-09-29 |
| Last Update Date | 2018-05-10 |