| NPI | 1053742692 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: KY 1005) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MI 2601000109) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: OH 003553) | |
| Enumeration Date | 2013-12-09 |
| Last Update Date | 2013-12-09 |