NPI | 1073059986 |
---|---|
Former Name | COURTNEY LEIGH CASTILLO |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CO AT.0001558) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO AT.0001558) |
Enumeration Date | 2017-01-16 |
Last Update Date | 2018-03-17 |