NPI | 1700277068 |
---|---|
Former Name | JESSICA GUREKOVICH |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: WA A160070207) |
Enumeration Date | 2015-02-09 |
Last Update Date | 2015-02-09 |