| NPI | 1114219466 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZS0410X Specialist/Technologist, Other Surgical Technologist |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: OR AT-AT-10139459) |
| Enumeration Date | 2011-05-04 |
| Last Update Date | 2014-03-04 |