NPI | 1326448002 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NE 832) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NE 2651) |
Enumeration Date | 2014-08-29 |
Last Update Date | 2021-09-30 |