| NPI | 1275712085 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IN 36001632A) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: WI 930-039) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MI 2601001324) | |
| Enumeration Date | 2007-10-29 |
| Last Update Date | 2021-05-04 |