NPI | 1508801457 |
---|---|
Former Name | MAGDALENA MYSLIWIEC |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IL 096002135) |
Enumeration Date | 2006-06-17 |
Last Update Date | 2020-05-04 |