| NPI | 1194287714 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: OR AT-10200149) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: AZ 001571) |
| Enumeration Date | 2019-04-02 |
| Last Update Date | 2019-06-18 |