| NPI | 1144493750 |
|---|---|
| Former Name | JESSICA FAYE LUSTBADER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NY 001534-1) |
| Enumeration Date | 2008-04-04 |
| Last Update Date | 2015-10-18 |