| NPI | 1164968210 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: MI 2601002113) |
| Additional Taxonomies | 207PS0010X Emergency Medicine Sports Medicine (Licence: PA RT00687) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-01-12 |
| Last Update Date | 2020-05-12 |