| NPI | 1083120042 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: ME AT593) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: ME 28559) |
| Enumeration Date | 2017-12-28 |
| Last Update Date | 2017-12-28 |