| NPI | 1104881184 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: TN AT 0000001646) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: TX AT 2999) |
| 2255A2300X Specialist/Technologist Athletic Trainer (Licence: AL 1200) | |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2014-03-18 |