NPI | 1497144539 |
---|---|
Former Name | MEGAN MARIE MCCULLOUGH |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MI 2601001074) |
Enumeration Date | 2015-01-13 |
Last Update Date | 2015-04-01 |