| NPI | 1548711583 |
|---|---|
| Former Name | LAURA YASUKO GOODWELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NY 003202-1) |
| Enumeration Date | 2016-10-14 |
| Last Update Date | 2016-10-14 |