| NPI | 1104294701 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: KS K03-07-4044) |
| Enumeration Date | 2015-09-13 |
| Last Update Date | 2018-06-21 |