NPI | 1588128565 |
---|---|
Former Name | AMANDA PATRICE GUESS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MO 20150002145) |
Enumeration Date | 2019-01-24 |
Last Update Date | 2019-01-24 |