| NPI | 1063182483 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: SC 03270) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: PA 1038455) |
| Enumeration Date | 2021-09-16 |
| Last Update Date | 2022-07-28 |