| NPI | 1700453420 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NE 917) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: NE 24162) |
| Enumeration Date | 2021-06-10 |
| Last Update Date | 2021-06-10 |