| NPI | 1609121466 |
|---|---|
| Former Name | JENNIFER LEE WEIDMAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IL 096.002603) |
| Enumeration Date | 2012-07-18 |
| Last Update Date | 2012-07-18 |