| NPI | 1679204267 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CT 000411) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: CT 007199) |
| Enumeration Date | 2022-06-23 |
| Last Update Date | 2022-06-23 |