| NPI | 1285241620 |
|---|---|
| Former Name | LARISSA JEAN MILLER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: PA RT005856) |
| Enumeration Date | 2020-09-29 |
| Last Update Date | 2020-09-29 |