| NPI | 1386014736 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: VA 0126002416) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: E3150340) |
| Enumeration Date | 2015-09-29 |
| Last Update Date | 2015-09-29 |