| NPI | 1164815809 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CT 1084) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: CT 22885) |
| Enumeration Date | 2015-03-05 |
| Last Update Date | 2019-02-24 |