| NPI | 1598295578 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: PA RTO000198)  | 
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: KY AT1186)  | 
| Enumeration Date | 2017-06-13 | 
| Last Update Date | 2017-06-13 |