| NPI | 1306154505 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MI 19739) |
| Additional Taxonomies | 246Z00000X Specialist/Technologist, Other (Licence: CO 10-0617) |
| Enumeration Date | 2010-09-22 |
| Last Update Date | 2010-09-22 |