NPI | 1568756245 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL AL 1965) |
Additional Taxonomies | 246Z00000X Specialist/Technologist, Other (Licence: WA A1 60339447) |
Enumeration Date | 2011-05-31 |
Last Update Date | 2015-04-14 |