| NPI | 1205237427 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: SD 0510) |
| Additional Taxonomies | 207PS0010X Emergency Medicine Sports Medicine (Licence: IA 000893) |
| 207PS0010X Emergency Medicine Sports Medicine (Licence: NC 2321) | |
| Enumeration Date | 2014-09-07 |
| Last Update Date | 2023-10-09 |