| NPI | 1629846886 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MT ATR-LAT-LIC-2548) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: CO SA.0003256) |
| Enumeration Date | 2023-12-18 |
| Last Update Date | 2024-10-17 |