| NPI | 1316490865 |
|---|---|
| Former Name | MARY ELIZABETH GREEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: VA 0126002041) |
| Enumeration Date | 2016-08-02 |
| Last Update Date | 2016-08-02 |