| NPI | 1326662677 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2020-06-02 |
| Last Update Date | 2024-04-03 |