| NPI | 1710176441 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TN 2096) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: PA RT004141) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MI 2601000218) | |
| Enumeration Date | 2007-10-18 |
| Last Update Date | 2016-11-16 |