| NPI | 1497258677 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MA 3486) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CT 1553) | |
| Enumeration Date | 2018-03-14 |
| Last Update Date | 2021-01-26 |