NPI | 1306551924 |
---|---|
Former Name | HALEY CAMPBELL |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IL 096004753) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MO 2019015073) |
Enumeration Date | 2023-01-18 |
Last Update Date | 2023-01-18 |