| NPI | 1235187337 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: MO 2004010790) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: KS 24-00313) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2007-07-08 |