| NPI | 1508129412 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246Z00000X Specialist/Technologist, Other (Licence: CT 957) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: MA 2264) |
| 2255A2300X Specialist/Technologist Athletic Trainer (Licence: TX AT2950) | |
| Enumeration Date | 2012-06-18 |
| Last Update Date | 2014-12-02 |