| NPI | 1063455608 |
|---|---|
| Former Name | LISA MARIE WHITE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225500000X Specialist/Technologist (Licence: ID AT-374) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: OR AT-AT-148663) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2016-12-03 |