| NPI | 1669009262 |
|---|---|
| Former Name | CARLY ELIZABETH LEWIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34.016385) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: OH 34.016385) |
| 2255A2300X Specialist/Technologist, Athletic Trainer | |
| Enumeration Date | 2020-03-24 |
| Last Update Date | 2024-09-03 |