| NPI | 1609428507 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer |
| Additional Taxonomies | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2019-07-10 |
| Last Update Date | 2020-09-02 |