| NPI | 1336543180 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MN 2954) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IL 096.003832) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MI 2601001780) | |
| Enumeration Date | 2014-10-22 |
| Last Update Date | 2017-07-16 |