NPI | 1336609254 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: PA RT007005) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: DE J3-0000756) |
Enumeration Date | 2019-03-25 |
Last Update Date | 2019-03-25 |