NPI | 1104573575 |
---|---|
Former Name | MADISON BARBER |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: IN 36003731A) |
Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer |
Enumeration Date | 2022-03-07 |
Last Update Date | 2023-05-30 |