| NPI | 1073014130 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NV 0506465) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: KY e3185372) |
| Enumeration Date | 2018-02-23 |
| Last Update Date | 2020-10-20 |