| NPI | 1598486938 |
|---|---|
| Former Name | KIRA RYNEA BACON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MO 2023028143) |
| Enumeration Date | 2022-09-05 |
| Last Update Date | 2024-11-05 |