| NPI | 1700257169 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246Z00000X Specialist/Technologist, Other (Licence: KS 24-01117) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MN 2602) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: ND 529-14) | |
| Enumeration Date | 2015-10-12 |
| Last Update Date | 2016-12-21 |