| 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 |