| NPI | 1467834192 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: LA 200325) |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: LA 008432) |
| Enumeration Date | 2015-06-18 |
| Last Update Date | 2015-06-18 |