NPI | 1508443524 |
---|---|
Former Name | KATHLEEN RYAN LALONDE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MI 2601001181) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: 2000000907) |
Enumeration Date | 2021-03-25 |
Last Update Date | 2021-03-25 |