| NPI | 1285257881 |
|---|---|
| Former Name | ALISSA MASTRODOMENICO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IL 096-004079) |
| Enumeration Date | 2020-05-19 |
| Last Update Date | 2020-05-19 |