| NPI | 1114333267 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CT 76802) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 57.251712) |
| 2255A2300X Specialist/Technologist, Athletic Trainer | |
| Enumeration Date | 2014-07-09 |
| Last Update Date | 2025-05-14 |