| NPI | 1194265280 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MN 2777) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: ND 696-15) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: SD 0545) | |
| Enumeration Date | 2017-03-08 |
| Last Update Date | 2017-03-08 |