| NPI | 1073079802 |
|---|---|
| Former Name | LISA B CHOMKO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 225800000X Recreation Therapist |
| 246Z00000X Specialist/Technologist, Other | |
| 2255A2300X Specialist/Technologist, Athletic Trainer | |
| Enumeration Date | 2019-02-18 |
| Last Update Date | 2019-02-18 |